Lipid Management and Cardiovascular Risk Assessment

Core Lipid Testing

The European Society of Cardiology recommends measuring LDL-cholesterol (LDL-C) as the primary lipid measurement for screening, risk assessment, diagnosis, and treatment monitoring in patients with high cholesterol 1, 2
HDL-cholesterol (HDL-C) is an independent risk factor and should be measured as part of the risk assessment, according to the European Heart Journal 2
Non-HDL-cholesterol is a strong independent risk marker, particularly valuable in patients with elevated triglycerides, diabetes, obesity, or very low LDL-C, as stated by the European Heart Journal and Mayo Clinic Proceedings 2, 3
Triglycerides should be measured to identify hypertriglyceridemia and assess the need for additional therapies, as recommended by the Journal of the American College of Cardiology and Metabolism: Clinical and Experimental 4, 5

The European Heart Journal recommends measuring lipoprotein(a) [Lp(a)] at least once in every adult's lifetime to identify those at very high lifetime cardiovascular risk 1, 3
Lp(a) levels are genetically determined and remain stable throughout life, making early identification crucial for aggressive management of other modifiable risk factors, as stated by the European Heart Journal 1
Very high Lp(a) levels help further stratify risk in patients with a family history of premature cardiovascular disease or those at borderline risk categories, according to Mayo Clinic Proceedings 3

The European Society of Cardiology recommends calculating total cardiovascular risk using a validated risk estimation system, such as SCORE in Europe or pooled cohort equations in the US, for asymptomatic adults >40 years without established cardiovascular disease, diabetes, chronic kidney disease, or familial hypercholesterolemia 1, 2
Additional biomarkers with the strongest evidence for risk enhancement include high-sensitivity C-reactive protein (hs-CRP), coronary artery calcium (CAC) scoring, and ankle-brachial index, as stated by the Journal of the American College of Cardiology 7, 8

The Journal of the American College of Cardiology recommends assessing for diabetes mellitus, chronic liver or kidney disease/nephrotic syndrome, hypothyroidism, and medications that increase triglycerides in patients with moderate hypertriglyceridemia (175-499 mg/dL or 2.0-5.6 mmol/L) 4

The European Heart Journal and Journal of the American College of Cardiology recommend follow-up lipid testing to assess treatment adherence and response to therapy, achievement of risk-based LDL-C goals, and need for treatment intensification if goals are not achieved within 8 weeks 2, 7
The American College of Cardiology recommends achieving risk-based LDL-C goals of <70 mg/dL (<1.8 mmol/L) for very high-risk patients or <100 mg/dL (<2.6 mmol/L) for high-risk patients, as stated by the European Heart Journal and Journal of the American College of Cardiology 1, 2